Healthcare Provider Details

I. General information

NPI: 1851106066
Provider Name (Legal Business Name): CENTRIC CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 S FAIRGROUND ST SE
MARIETTA GA
30060-2354
US

IV. Provider business mailing address

236 S FAIRGROUND ST SE
MARIETTA GA
30060-2354
US

V. Phone/Fax

Practice location:
  • Phone: 678-903-5960
  • Fax: 678-903-5960
Mailing address:
  • Phone: 678-903-5960
  • Fax: 678-903-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA LAMARCHE
Title or Position: OWNER
Credential: DC, CCSP, ATC
Phone: 678-903-5960